Significant Role of Chemotherapy in the Treatment of Multiloculated Liver Abscesses Evaluated with CT and Angiographic Examinations

Abstract

The role of chemotherapy was evaluated in 2 cases of solitary multiloculated liver abscesses. Both patients were free of biliary tract diseases, liver trauma, iatrogenic causes and colorectal diseases. Angiography revealed a hypervascular abscess wall and increased flow of the hepatic artery. In the first case, pyelonephritis was accompanied by left renalstones, and Escherichia coli was isolated from the urine. Since a laboratory examination revealed liver dysfunction, a CT was performed which disclosed a liver abscess. A percutaneous nephrostomy and chemotherapy were performed. Pus from the abscess yielded Streptococcus sanguis, along with unidentified gram-positive rods and anaerobic gram-negative cocci. The liver abscess did not resolve in spite of percutaneous drainage and administration of imipenem, which may have been due to the presence of multiple septa. After the administration of piperacillin, the body temperature normalized, and fistulography revealed adequate drainage of the liver abscess which subsequently resolved. In the other case, the patient had pyorrhea with an accompanying right subphrenic abscess. Fusobacterium sp. were recovered from the pus of liver abscess. Flomoxef was administered for 17 days prior to percutaneous drainage. Serial CT examinations revealed the disappearance of septa in the liver abscess cavity, and the patient made an uneventful recovery after percutaneous drainage. Piperacillin and flomoxef are excreted into bile fairly well in the absence of biliary obstruction, which may indicate that the high biliary concentrations of these antimicrobial agents is responsible for the elimination of multiple septa and the favorable response of multiloculated liver abscesses to percutaneous drainage.